Siezures or epilepsy
Debra L. Balke, M.D.
The following was a parent education seminar presented in San Luis Obispo county to address questions about seizures, epilepsy, medications and the latest research. It is printed here with permission from the presenter, Debra L. Balke, M.D.
What is the difference between a "seizure" and "epilepsy or epileptic syndrome"?
EPILEPTIC SEIZURES are classified as "partial (focal)" or "generalized"
Partial (focal) seizures (abnormal electrical activity occurs in one part of the brain only)
Simple partial seizures (the child is awake during the seizure)
Common examples include one arm twitching ("clonic movements") or one leg becoming stiff ("tonic stiffening").
Complex partial seizures (the child is not fully aware during the seizure)
There may be a warning ("aura") before it happens, then confusion with some repetitive automatic behaviors like chewing, blinking, picking ("automatisms".) Sometimes a simple partial seizure turns into a complex partial seizure as more of the brain tissue becomes involved with abnormal electrical activity. There is confusion for about 20 minutes or more after the seizure itself stops ("the patient -was post ictal 20 minutes.") Sometimes the electrical activity can spread to involve the whole brain and a generalized seizure can then occur ("the child has complex partial seizures that secondarily generalize about 30% of the time.")
Generalized seizures (abnormal electrical activity involves the whole brain)
Absence seizures (used to be called "petit mat seizures") These usually occur in otherwise entirely normal children. Brief, sudden onset staring spells, hundreds of times a day, lasting about a minute or less, with no confused period afterwards.
Atypical absence seizures These are sort of like absence seizures but can be slow to come on and to stop, and can have a confused period afterwards. They can have clonic (twitching) and/or tonic (stiffening) of the body during the seizure sometimes.
Myoclonic seizures Quick jerking movements, usually when the child is awake. This is a more rare type of seizure and can occur in a wide variety of circumstances.
Clonic seizures Whole body twitching
Tonic seizures Whole body stiffening. Usually seen in children with delayed development.
Tonic-clonic seizures (grand mal) Stiff for seconds then turns into twitching movement
Atonic seizures (drop attack) Child instantaneously drops to the ground. Usually the child has many other types of seizures as well and has delayed development.
EPILEPTIC SYNDROMES are classified as either "primary" or "secondary:'
The word "primary" or "primary generalized epilepsy" is used to mean that usually there is no known problem with the brain chemistry or brain structure. Obviously, there is a problem somewhere, but the only test that is abnormal is the EEG which shows a specific pattern. Many of the primary epilepsies run in families ("its genetic"') and the children tend to do well overall.
The term "secondary" or "secondary generalized epilepsy" is used when it is suspected that there is a problem with either the brain structure or brain chemistry. Often, we suspect this brain problem after seeing a certain type of EEG abnormality, MRI/CT abnormality, or just based on delayed or abnormal development of the child. "This child has many different types of seizures, developmental delay and an EEG that is consistent with a secondary generalized epilepsy."
NOTE: Do not confuse the term "secondary generalized epilepsy" which refers to an epileptic syndrome with the phrase "complex partial seizure that secondarily generalizes" which refers to a seizure that spreads to involve the whole brain. Secondary vs. Secondarily. Yes. terrible terminology, but I didn't invent it!......
With generalized seizures With partial seizures
Primary epilepsies Absence epilepsy Rolandic epilepsy (benign epilepsy with centrotemporal spikes)
Many generalized tonic- Childhood epilepsy with occipital clonic seizures spikes
Juvenile myoclonic epilepsy
Benign neonatal seizures
Secondary epilepsies Infantile spasms Temporal lobe epilepsy Lennox-Gastaut syndrome (also called psychomotor) Epilepsies due to brain malformations Epilepsies due to brain injuries such as after lack of oxygen to the brain Conditions with Reactive Seizures Febrile seizures Partial seizures occur when (abnormal reaction Most toxic and reactive seizures are superimposed of an otherwise normal metabolic induced on transient or preexisting non -brain to physiologic seizures epileptogenic brain injury, such as stress or transient Many isolated tonic- seen with head trauma, metabolic epileptogenic insult) clonic seizures abnormalities
Early posttraumatic seizures
Among people with Mental Retardation end Epilepsy, 25-30% have specific syndromes:
SEIZURE MEDICATIONS ("antiepileptic drugs" "anticonvulsants")
During a seizure:
What should the emergency room or paramedics do?
If still seizing, oxygen is placed on the face and doses of Valium or Ativan are given IV or rectally. After two doses given about 5 minutes apart, IV Dilantin (phenytoin or fosphenytoin) or IV phenobarbitol or both are given. Sometimes the medicines make the child so sleepy that he forgets to breathe. In this case, a breathing tube is inserted while the doctors wait for the medicines to wear off a little.
Other things you should know:
Extremely individual. In general, the primary generalized epilepsy syndromes tend to do well and "febrile seizures" tend to have an excellent outcome. The secondary generalized epilepsy syndromes can be more difficult to treat, but with newer medications, the ketogenic diet, and epilepsy surgeries, we have many treatment options which can improve seizure frequency and have less effect on behavior and level of alertness than some of the older medications.
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